title: Current obesity, steady weight change and weight fluctuation as predictors of physical functioning in middle aged office workers: the Whitehall II Study.
abstract: OBJECTIVE
  (i) To investigate the effects of current obesity, steady weight change and weight fluctuation on physical functioning and (ii) to determine whether associations are independent of coronary heart disease.
  
  
  METHODS
  Prospective cohort study with body mass index (BMI) measurements at four time points between the ages of 25 and 63 y.
  
  
  METHODS
  British civil servants based in London offices at baseline.
  
  
  METHODS
  6895 men and 3413 women aged 35-55 y at baseline.
  
  
  METHODS
  Physical functioning was assessed using the 10-item scale from the Short Form 36 Health Survey, with a score in the lowest quartile indicating poor physical functioning.
  
  
  RESULTS
  After adjustment for age and confounders (employment grade, smoking, alcohol, exercise and menopausal status), current BMI was monotonically associated with poor physical functioning in women whereas a threshold effect at a BMI of 27 kg/m2 was seen in men. The odds ratio of poor physical functioning was 1.55 (95% confidence interval (CI) 1.02-2.35) amongst women and 1.04 (95% CI 0.77-1.41) amongst men with BMI 23-24.9 kg/m2 compared to those with BMI < 21 kg/m2. Women in the upper, compared to the lower, tertile of steady weight change, had an odds ratio of poor physical functioning of 1.79 (1.24-2.60) after adjustment for age, confounders, current BMI and weight fluctuation. Women in the upper, compared to the lower, tertile of weight fluctuation had an odds ratio of poor physical functioning of 1.70 (1.23-2.34) adjusting for age, confounders, current BMI and steady weight change. Adjustment for the presence of coronary heart disease did not substantially alter any of these associations. Steady weight change and weight fluctuation had no independent effects in men.
  
  
  CONCLUSIONS
  Among women, current obesity, steady weight change and weight fluctuation are independently and monotonically associated with poor physical functioning. Development of overt coronary heart disease is unlikely to be the mechanism for these associations.
authors.affiliation: MRC Childhood Nutrition Research Centre, Institute of Child Health, London, UK.
authors.forename: M
authors.initials: M
authors.lastname: Stafford
authors.forename: H
authors.initials: H
authors.lastname: Hemingway
authors.forename: M
authors.initials: M
authors.lastname: Marmot
mesh_terms: D000328:Adult; D015992:Body Mass Index; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000503:physiopathology*; D016017:Odds Ratio; D010809:Physical Fitness / Q000502:physiology*; D011446:Prospective Studies; D012737:Sex Factors; D011795:Surveys and Questionnaires